USERS WHO (REALLY) NEVER INHALE

From Capsules to Brownies to Oils and Even Tea, Medical Marijuana
Comes in Many Forms for Patients With Low Tolerance For, or Health
Concerns About, Smoke

Ian Layfield met a man at this year's medical marijuana conference in
Toronto who was waving around his federal licence to show people he
could legally use 150 grams of pot a day.

He seemed quite proud of the fact, Layfield remembered.

It seemed obvious the man had many chronic ailments that left him in
poor health.

But even so, Layfield, who is legally allowed to use nine grams of
medical marijuana a day to fight pain from severe arthritis, remained
skeptical.

"I think the 150 was a PR (public relations) stunt, that anything over
60 grams a day would be a waste," Layfield said from Victoria, where
he runs a mailorder marijuana company called MedMe. "I don't even know
how you could afford that" - especially given that many people in need
of marijuana for medical purposes are on disability pensions for
severe pain associated with HIV, arthritis, spinal cord injuries or
diseases, cancer or epilepsy.

At $5 a gram from the government's marijuana supply, or $8 to $10 a
gram at compassion clubs, the man would need $750, $1,200 or $1,500 a
day for his weed supply. And that didn't sound possible to Layfield.

He believes one patient could use a maximum of 50 grams a day, then
would likely sell the rest on the black market to generate income.

Health Canada recommends that patients use an average of one to three
grams a day, either by inhaling or in brownies, capsules, oils or
other baked goods. But between 2001 and 2007, only 777 medical
marijuana users were at that level out of a total 3,891 registered
with Health Canada.

Most - 1,609 people, or 41 per cent - were granted a licence to use
five grams a day. One Kelowna, B.C., man born in 1959 was approved to
use 56 grams a day for multiple conditions related to spinal cord
disease and injury.

Given that the government estimates one joint contains 0.5 to one gram
of pot, 56 grams seems like a lot of puffing. But David May, head of
security at the Medical Compassion Clinic in downtown Toronto, said
some patients may need that amount of marijuana because they are
converting it from the dried leaf form into caplets or oils which they
are better able to ingest.

Janice Cyre, 61, has fibromyalgia and lives on a farm outside
Edmonton. She can legally use 22 grams of marijuana each day. But
she's only allowed to inhale or vaporize three grams a day, and
another gram in a homemade cream she can apply to her hip and shoulder
when she is in extreme pain.

She steeps the last 18 grams in tea, making six cups of three grams
each. That, she explains, reduces the level of Delta 9 THC in the pot
- - a cannabinoid that bursts when its heated in a joint, bringing the
typical high and euphoria with it - and gives her better access to the
anti-inflammatories and other cannabinoids in the pot.

People with HIV, AIDS, hepatitis C and lung cancer can't smoke joints
or pipes because the plant matter burns their lungs, May said. They
may place their dried marijuana into special machines that spin and
tumble the leaves and buds and allow the trichome crystals on the
plant to fall into a glass underneath. The crystals - which hold much
of the Tetrahydrocannabinol or THC, the main active substance in the
cannabis plant - can then be ingested in capsule form.

But May said 10 to 14 grams of dried marijuana is needed to make one
edible capsule, which can supply pain relief for a long time. So
someone allowed to use 56 grams of pot each day might be using it to
make just five or six capsules.

"A lot of people who cannot smoke anymore will only use the
trichomes," May said. "They won't even use the plant anymore, and
that's why their numbers (per daily dosage) are so high."

About 28 grams of pot are needed to make one gram of oil, May said.
That can be used for baking. One pinhead of oil - equivalent to one
joint, May said - can be spread on rolling paper or dabbed onto a
metal pad in a pipe.

"It's pure. It's a lot cleaner and it works better," he said. "A lot
of people are getting away from smoking because smoking is bad and
everybody knows it, so everybody is trying to move into different ways
of consuming it without hurting themselves."

But that also puts compassion clubs in a pickle. While individual
users are allowed to convert dried leaves into other forms of
medication for themselves, Canadian law makes it illegal for them to
sell the capsules or oils. Edmonton's compassion club sells only dried
leaves and usually only one or two different strains at a time.

Others, such as the B.C. Compassion Club Society in Vancouver - the
oldest and largest in Canada - sell half cups of butter or jars of
cannabis-infused pesto for $15. Olive oils, baked gingersnap cookies -
three for $7 - and alcohol tinctures or drops for under the tongue or
in tea are available as well as dozens of leaf strains. Lengthy menus
of Blueberry, Bella or Sugar Shack marijuana describe "spicy,"
"smooth" or "resinous" tastes and frosty nuggets that specifically
target nausea or pain, or give people energy or help them sleep.

May said most people don't have the chemistry expertise or the money
to convert their marijuana leaves into other forms. Machines such as
vaporizers, which convert the buds into vapours rather than smoke,
cost between $200 and $1,000.

"That's why compassion clinics exist now to teach people how to learn
it better, do it healthier," May said from Toronto. "A tincture is
what the Royal Family has been using for over 200 years. That's the
recipe we use, the Royal Recipe."

Yet Isaac Oommen, communications co-ordinator for the B.C. Compassion
Club, said his club sells a maximum of 15 grams of marijuana a day to
each patient.

Dr. Brian Knight is an anesthetist and pain physician in Edmonton. The
highest daily dosage he has prescribed is 10 grams a day, though he
usually begins at two grams.

People in the industry agree: Patients should start with small doses,
and if they are ingesting rather than inhaling marijuana, they need to
give themselves more time to feel the effects. In the end,
prescriptions have to be personalized. Someone with chronic epileptic
seizures may need 56 grams of marijuana a day to keep control of their
body.

"I've seen this do miracles for people," May said. "I've seen people
come off crack cocaine. I've seen people with Tourette syndrome that
were totally dysfunctional, totally functional now. They actually want
to go to university."

[sidebar]

Alberta statistics (2001 - 07)

- - Highest dose: 20 grams per day, for patient with multiple
sclerosis

- - Smallest dose: 0.1 grams per day, for patient with multiple
sclerosis

- - Most common dose: 5 grams a day

Who is doing the most prescribing?

- - General practitioners accounted for 103 prescriptions

- - Physicians in neurology accounted for 94 prescriptions

- - Psychiatrists wrote 68 prescriptions

378 Albertans are registered with Health Canada to use medical
marijuana:

- - Males: 236

- - Females: 140

- - Unknown: 2

- - Edmonton: 149 patients

- - Calgary: 49 patients

At end of 2007:

- - Oldest: 81

- - Youngest: 18